Non-invasive modalities for predicting lymph node spread in early stage endometrial cancer?

Abstract

Background: Lymph node status in EC determines the staging and has important prognostic and therapeutic implications.

Objectives: We have examined the diagnostic value of preoperative and intraoperative non-invasive methods to determine the lymph node status in endometrial cancer, or, indirectly, for identification of patients at increased risk of lymph node involvement.

Search strategy: We conducted a literature search to identify all relevant reports that evaluated lymph node spread in EC.

Selection criteria: Articles were only considered when data of investigational modalities were compared with histopathological findings of the surgical specimens, considered as the gold standard.

Data collection and analysis: When numerous relevant articles were identified for one investigational modality, only series including more than 50 patients were considered.

Main results: Sensitivity of CT and MRI for diagnosis metastatic lymph node is limited. TVS performs as well as MRI in predicting deep myometrial invasion. It is unclear whether intraoperative gross visual examination and frozen section perform better than preoperative methods to predict deep myometrial invasion. There is a limited sensitivity of intraoperative frozen section for predicting poorly differentiated EC.

Conclusion: Accurate non-invasive assessment of lymph node status in patients with EC remains challenging.

Synopsis: Despite imaging advances in the past 20 years, accurate non-invasive assessment of lymph node status in patients with EC remains challenging.